Updates on Lisfranc Complex Injuries

Yan, Alan Y.; Chen, Stephen R.; Ma, Xin; Shi, Zhongmin; Hogan, MaCalus V.

doi:10.1177/2473011420982275

Cited by 18 publications

(25 citation statements)

References 67 publications

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“…24 It has been shown to have moderate interrater reliability 16,22,29 but has not gained traction as an effective tool in predicting out come. 30,34 Our work evaluated reliability of the Hardcastle Myerson system and found commensurate interrater reliability to previously reported work. 16,22,29 It was useful in the present study as a means of stratifying injury pat terns in relation to specific injury features (fractures and incongruity).…”

Section: Discussionsupporting

confidence: 77%

“…What becomes clear is that there are numerous injury patterns, and although many proposed systems exist, there remain no commonly agreed on methods of describing Lisfranc injuries. 30,34 For this reason, it may be beneficial for future classification systems to include information on location of fractures and degree of displacement. Data from the present study may be of use in this regard.…”

Section: Discussionmentioning

confidence: 99%

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The First Tarsometatarsal Joint in Lisfranc Injuries

et al. 2022

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Background: Lisfranc injuries are among the most debilitating injuries to the foot. Characterization of first tarsometatarsal (TMT) joint involvement in Lisfranc injuries is limited. Multiple studies have indicated that this joint is damaged in a variety of Lisfranc injury patterns, but there is sparse information regarding how often and in what form. Methods: A retrospective review was performed of operative Lisfranc fractures from 2010 to 2020 with patients identified by Combined Procedural Terminology codes. Hardcastle and Myerson Lisfranc injury classifications and computed tomography and radiograph characterizations of the first TMT joint were evaluated by 3 foot and ankle fellowship–trained orthopaedic surgeons. Radiographic characteristics were collected. Light’s kappa coefficient evaluated interrater reliability for injury classification. Injury mechanism and Lisfranc classification effects on the first TMT joint were further assessed using inferential statistics. Results: Of 71 patients with a Lisfranc injury of which 37 (52%) were high energy, 61 (86%) showed radiographic evidence of first TMT joint injury. A fragment was present in the TMT articular surface in 33 (47%) with median size = 8.7 mm and medial capsular avulsion in n = 25 (35%). Forty-eight patients (68%) had medial/lateral TMT joint incongruence ≥2 mm (median overhang = 4 mm), 21 (30%) had dorsal/plantar incongruence (median overhang = 6 mm). Angulation of TMT articular surfaces ≥5 degrees on the transverse/anteroposterior plane occurred in n = 32 (45%) and in n = 12 (17%) on the sagittal/lateral plane, which significantly differed between classifications ( P = .020). Conclusion: The overwhelming majority of Lisfranc midfoot injuries seen at our tertiary referral center had imaging evidence of damage to the first TMT joint (86%), and the incidence may be higher. The most common patterns of first TMT joint involvement we found were joint incongruity, articular surface fractures, angulation of the articular surfaces, and medial capsular ligament avulsion fractures. A better understanding of injuries to the first TMT joint can help orthopaedic surgeons with diagnosis.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

The First Tarsometatarsal Joint in Lisfranc Injuries

et al. 2022

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“…Diastasis at the Lisfranc joint (MC-2MT) ≥2 mm was indicative of failure based on previous studies evaluating this structure and other ligaments in the foot. 7 , 14 , 34 , 48 …”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

et al. 2022

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Background: The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. Purpose: To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal–medial cuneiform joint). Results: There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. Conclusion: The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. Clinical Relevance: Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.

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“… 18 , 38 No consensus, however, exists as to whether metalwork should be routinely removed following fixation of Lisfranc injuries. 44 , 47 …”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Outcomes Following Lisfranc Injury Fixation: Removal vs Retention of Metalwork

Rhodes

McMenemy

Connell

et al. 2022

Foot & Ankle Orthopaedics

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Background: Following Lisfranc injury fixation, no consensus exists on whether to routinely remove metalwork. The aim of this study was to evaluate functional outcomes and complications in patients following routine removal of metalwork and in those with retained metalwork. Methods: A systematic review of literature (1999-2020) reporting results of metalwork removal vs retention following Lisfranc injury fixation, was undertaken. The primary outcome was functional outcomes at 1 year following index surgery. Secondary outcomes were rates of complications including unplanned removal of metalwork. Results: No studies directly comparing routine metalwork removal vs retention were found. A total of 28 studies reporting on 1069 patients were included. Of these, 10 studies (317 patients) reported on retention and 18 (752 patients) on routine removal of metalwork. The difference in the American Orthopaedic Foot & Ankle Society (AOFAS) score between removal and retention groups was 3.38 (95% CI 6.3-0.48), P = .02 (removal 79.97 [±16.09; 71-96]; retention 76.59 [±20.36; 65.4-94]). No difference in reported rates of infection was found between the 2 groups (0%-12% for both groups). Of the 317 patients in the retention group, metalwork was removed in 198 cases, resulting in a 62.5% unplanned removal rate. Conclusion: In conclusion, this systematic review found limited evidence comparing different strategies of metalwork management after Lisfranc injury fixation. A randomized controlled trial is necessary to elucidate if routine removal of metalwork confers any true benefit. Level of Evidence: Level IV, systematic review including case series.

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Updates on Lisfranc Complex Injuries

Cited by 18 publications

References 67 publications

The First Tarsometatarsal Joint in Lisfranc Injuries

The First Tarsometatarsal Joint in Lisfranc Injuries

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

A Systematic Review of Outcomes Following Lisfranc Injury Fixation: Removal vs Retention of Metalwork

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